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Here We Go Again!


Thank you for including me on your 365 day round trip around the sun. It is an honor to travel with you. I was hoping we would get a group discount but our tickets are full priced and nonrefundable so let’s get as much as we can out of our adventure.

When it comes to work, I don’t mind admitting that I have spent needless time wondering what direction to take. Just when major health care reform was finally a ‘reality’, the partisan makeup of the house has changed and the republicans are working hard to repeal it. Face to face visits? Still no real details but that is now a problem for March. Meanwhile, don’t let an opportunity for your patient to see the physician pass you by. All those changes scheduled for 2012? I can’t think about those right now.

But we are not politicians. We take care of elderly people, living their homes. That is what we do.

We only have one challenge to meet. How do we do it better? Here are five of my ideas.

  1. We keep patients away from hospitals. Hospitals are dangerous places and we do not want our patients to spend even one day hospitalized when they could be at home with their families.
  2. We fully develop the potential of our nursing staff. Robert Wood Johnson Foundation spent millions of dollars coming up with the recommendation that nurses should work to the fullest extent of their education. Who are we to ignore such an expensive piece of advice shared with us for free? (By the way, the study really was good. Read it if you have the chance.)
  3. We must manage cash better at all levels of the organization keeping in mind that being cheap is never a sound alternative to being conservative with money. Yes, this includes nurses. We became gatekeepers of revenue the day PPS was implemented.
  4. We need to increase visibility and respect in our communities. As an industry and as singular agencies, increased visibility and respect will help validate our need to those who refer to us, pay for our services and most importantly, receive our services.
  5. We must shift our mindset from recruiting to retaining (good) nurses. In every other industry, the value of an employee increases with time and experience in an organization. We don’t get to experience the kind of expertise and knowledge that comes from years of working within a single organization very often in our field.

These are my five approaches to improving the overall health of our industry. If we do one through five, then the politics will take care of themselves. If our patients do well, so do we. That’s how it works.

But, please, please share any thoughts you have with us. Surely someone else has something that needs to be added to the list! Please leave a comment below or email me directly.


2 Comments Post a comment
  1. gail #

    Your #1 “challenge” gave me pause to ponder. I worked in a
    hospital for 10 years before I came to Home Health. And you are
    right. It’s good to keep people out of the hospital. Scenario:
    elderly patient with multiple medical problems is referred to home
    health. We get him all educated, able to manage medications, PT
    helped with gait and balance, can name all the right things to do
    with diet, and is all “stable.” So, since there is no “skill” we
    discharged him. But, he is forgetful, alone in the home,(lonely)
    dependent on friends and family to “help out” and runs out of
    medicine because he “forgot” to reorder, can’t remember about all
    that dietary “stuff” that we constantly reminded him of, had a fall
    and scraped his arm that is now infected because there was no one
    to come clean and dress it; and has to be admitted back to the
    hospital. Here we go again. And the “kids” who see him now and then
    decide that he’d be better off in the nursing home. What’s the
    point? A person that could stay in his own home with supervision
    and monitoring by home health, is now back in the hospital and
    probably going to the nursing home because he can’t take care of
    himself. I am more than puzzled; I am dismayed. Gail Batson, RN,
    MSN Quality Coordinator Harmony Home Health Natchitoches,

    January 11, 2011

    • You have very eloquently stated one of my frustrations. Home Health is designed as a Medicare Benefit for acute needs of homebound patients. And we do a great job. However discharge can be very painful – especially here in the deep south where resources are very limited. I do know that the regulations for waived caregiver services through Medicaid have been lightened but that only goes so far and is generally only available to Medicaid patients. I swear, there are times I feel like pushing patients down the stairs so they will be eligible for another episode of home health and can avoid the Nursing Home admission just a little longer.

      Thank you for your comment and for the opportunity to whine a little bit about Medicare. It always makes me feel better.

      January 11, 2011

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